Support The Healthy Montana Initiative

A faction of extreme right legislators banded together during the last session to refuse the federal funds to pay for 100% of the health care benefits for working poor Montanans.

What Cowgirl glosses over is the mistaken vote from Democrat Tom Jacobson that ultimately kept Medicaid expansion dead in committee. Here is how the Washington Post described how that disastrous vote got miscast:

“It was near the end of the session,” says Jacquie Helt, director of SEIU Healthcare 775 Northwest, who had lobbied hard for the expansion. “I can’t imagine the fatigue they’re all feeling at that point.”

This is when “the vote” — as many Montanans I spoke with described the mistaken ballot — occurred. When the Medicaid expansion bill came up, Republican House Speaker Mark Bladsel motioned for the legislation to be sent back to committee, where many observers expected that it would languish.

Here’s how Hunter describes what happened next. “It was tense,” he says. “I’m standing up, I’m appealing the speaker’s decision and he’s reading the rule [that says he can refer it to committee.].

“We had some procedural motions to challenge the speaker. One of our Democratic members pushed the wrong button. That procedural motion failed on a tied vote.”

That legislator was Tom Jacobson, a freshman from a central Montana town called Great Falls. Jacobson told local reporters that he got the vote wrong, although he did not respond to my phone calls and e-mail requesting comment.

Montana’s House rules do generally allow legislators to change their votes (Bangarter told me that these changes were generally accompanied by a $20 donation to charity, but I could not find anything about that in the statute). They do not, however, allow legislators to change their vote if “it would affect the outcome of legislation.” And in this case, it would change the outcome: One vote flipping would mean the Medicaid expansion would make it to the floor.

“We got very close to pulling this off,” Montana Hospital Association’s John Flink says. “If the person who made the mistake had voted the correct way, the bill would have gone to the floor. We had the votes there.”

So unlike the other 20+ plus states that saw a chance to figuratively punch poor people in the face, Montana has the dubious distinction of being the one state that turned its back on Federal Medicaid funds because a freshman legislator voted the wrong way, and this is part of the consequence of that vote:

In states that have opted not to expand, adults earning more than 100 percent of the poverty level, but less than the 139 percent or above required to be eligible for subsidies on the PPACA-administered exchanges, will find themselves in a health coverage no-man’s land.

In effect, millions of adults who otherwise would have qualified for coverage will find health care still out of their reach.

Mental health experts across the country warn that pulling the carpet from under the country’s poorest and most vulnerable — the mentally ill — will force them to turn to more costly, and less effective, channels such as emergency rooms.

In Missouri, “hospitals are decreasing their psychiatric beds because [those patients] are the highest percentage of non-payers,” says Diane Maguire, a director at Places for People, another community health center in Missouri. “Often the people we serve are not able to get services at more traditional agencies due to their active symptoms.”

It also will strain law enforcement, which is often forced to respond to emergencies involving the untreated mentally ill and typically needs to transport patients to distant centers. Prisoners with mental illness cost the nation an average of nearly $9 billion a year, according to the National Alliance on Mental Illness.

Gee, I wonder if there is any common sense approach that could be both a more humane way of treating those in our community with mental illness, and also save money?

“The numbers are stunning,” Andrae Bailey, the CEO of the Central Florida Commission on Homelessness, told the Orlando Sentinel. “Our community will spend nearly half a billion dollars [on the chronically homeless], and at the end of the decade, these people will still be homeless.”

Bailey is referring to numbers recently found by Creative Housing Solutions, which tracked public expenditures on local homeless people in the Central Florida region. Because of costs like frequent emergency room visits, hospital admissions and repeated arrests for homeless-related crimes, the analysis estimated each homeless person costs taxpayers $31,065 each year. To put that into perspective, providing the chronically homeless with permanent housing and case managers to supervise them would be about $10,000 per person each year.

As astounding as those numbers may seem, the data isn’t as groundbreaking as you might think.

The University of North Carolina at Charlotte released a study in March that found housing chronically homeless adults produced a 78 percent reduction in emergency room costs — a price tag that would have eventually been passed on to the taxpayer — the Charlotte Observer reported. The numbers also showed the previously homeless tenants in the study spent 84 percent fewer days in jail, largely due to a decrease in crimes like loitering and begging.

In lieu of a special session called by the Governor to grapple with expanding Medicaid coverage, there is the Healthy Montana Initiative (I-170). Across the state, Montanans will have the opportunity to voice their support for I-170 by providing signatures. If you are a registered Montana voter who sees the benefit of covering 70,000 people in this state and creating 20,000 jobs, we need your help.